DI 22501.001:
Disability Case Development for Evidence
Effective Dates: 03/02/2016 - Present- Effective Dates: 12/05/2017 - Present
TN 23 (11-12)- TN 27 (12-17)
DI 22501.001 Disability Case Development for Medical and Other Evidence- DI 22501.001 Disability Case Development for Evidence
- Citations:
- Social Security Act - Sections 223(d), 1614(a), 1631(e)
Regulations - 20 CFR sections 404.1512 through 404.1516, 404.1520, 416.912 through 416.916, and 416.920- Regulations - 20 CFR sections 404.1512 through 404.1516, 404.1520, 404.1520b, 416.912 through 416.916, 416.920, and 416.920b
- A. Purpose of case development
We develop medical and other evidence to establish:- We develop evidence from medical and nonmedical sources to establish:
- * whether the claimant is disabled or blind,
and as needed,- * the date disability began, and
* the date disability ended.- * the date disability ended, if applicable.
- B. Definition of evidence
Evidence is any medical or non-medical information the claimant or anyone else submits, or we obtain, that relates to the disability claim.- Evidence is anything the claimant or anyone else submits to us, or that we obtain, that relates to the claim for disability benefits.
- For the categories of evidence, see DI 24503.005B.
At each level of adjudication, evidence may include, but is not limited to:* Objective medical evidence: * medical signs, and * laboratory findings.* Narrative medical records from medical sources: * medical history, and * treatment records.* Medical source opinions and statements, including those from: * state agency and regional medical consultants (MC) or psychological consultants (PC) and other program health care professionals, and * consultative examination (CE) sources.* Statements from the claimant or others about the claimant’s: * impairment(s), * restrictions, * daily activities, and * efforts to work.* Any relevant statements the claimant makes: * to medical sources, during the course of examination or treatment, or * to the field office (FO) or Disability Determination Services (DDS), during face-to-face or telephone interviews, on applications or other forms such as function reports or work history, in letters, and in testimony during an administrative hearing.* Information from other sources, including: * educational personnel, * social welfare agency personnel, and * other medical and non-medical sources. For examples of medical sources and non-medical sources, see DI 22505.003B.3.* Decisions by any government or non-government agency about whether the claimant is disabled or blind.* A report of investigation (ROI) prepared by the Office of the Inspector General or Cooperative Disability Investigations Unit; see DI 23025.020A.2.- For details on what is not considered evidence, see DI 24503.001B.
- C. Evidence we consider for a disability determination
We consider all relevant evidence in the case folder when making a disability determination. This includes relevant evidence we:* have in our records, including relevant evidence from available prior folders,* receive from the claimant, and* develop from medical and other sources.For a definition of relevant evidence, see DI 20503.001B.2.D. Completeness of medical and non-medical evidenceCase evidence must be complete and detailed enough to permit an independent determination about whether the claimant is disabled or blind. The evidence must allow adjudicator(s) to determine:* the nature and limiting effects of the claimant’s impairment(s),* whether the 12-month duration requirement is met or is expected to be met,* the claimant’s residual functional capacity (RFC) to do work-related physical and mental activities at Steps 4 and 5 of sequential evaluation, and* the established onset date (EOD).- We consider all relevant evidence in the case record when making a disability determination. This includes the following evidence we have:
- * in our records, including relevant evidence from available prior folders,
- * received from medical sources, and
- * received from nonmedical sources, including the claimant.
- NOTE: When the adjudicator considers evidence from a prior folder(s), the evidence from the prior folder(s) must be included in the current case folder.
- For the definition of relevant evidence, see DI 24515.001B.2.
- D. Completeness of medical and other evidence
- The evidence we receive must be complete and detailed enough to permit an independent determination about whether the claimant is disabled or blind.
- Therefore, the evidence must allow the adjudicator(s) to determine:
- * the nature and severity of the claimant’s impairment(s),
- * whether the 12-month duration requirement is met,
- * the claimant’s residual functional capacity when steps 4 and 5 of sequential evaluation apply, and
- * the established onset date, if applicable.
- When there is enough evidence, the adjudicator should be able to understand how the claimant functions on a day-to-day basis.
When there is enough evidence, the adjudicator should be able to picture how the claimant functions on a day-to-day basis.- NOTE: The adjudicator may discontinue development when the evidence is consistent and sufficient to make a fully favorable determination. For details, see Expedients to Evaluate and Develop Evidence for Potential Mental and Physical Impairments in section DI 24505.030.
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